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Annotated abstract

Missing barrier in coeliac disease: why the gut vascular barrier matters

gutjnl · 2026-07-09 · canonical JSON source

2 visible annotations · policy: published · automated confidence ≥ 75.00%

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We read with great interest the review by Damianos et al.1 The authors provide a comprehensive synthesis of epithelial barrier (EpB) dysfunction in coeliac disease (CeD), highlighting tight junction alterations, zonulin signalling, immune activation and therapeutic strategies aimed at restoring barrier integrity. However, we believe that this framework remains incomplete because it focuses predominantly on the EpB with limited attention to the gut vascular barrier (GVB) as a distinct determinant of permeability.2 The EpB regulates passage from the intestinal lumen into the lamina propria, whereas the GVB governs subsequent translocation from the lamina propria into the portal and systemic circulation.2 These barriers are biologically linked but they are not synonymous. A model centred only on epithelial leak risks overlooking the step at which local mucosal disturbance becomes clinically consequential systemic exposure.